Frequently Asked Questions about Therapy

Do I Need Psychotherapy? You do not need to be “crazy” to benefit from psychotherapy. Most people seeking help are struggling with life problems, but the usual way that they cope just isn’t working. Some feel recurrent periods of dissatisfaction with their life and an accompanying sense that there is more potential for a satisfying life in the waiting. Some people talk to a therapist because they don’t feel like they can talk to anyone else about what's bothering them. Everyone I have worked with has a unique life story complete with its hardships, challenges and triumphs. They may have been struggling on and off with feeling down or worried. Sometimes they thought about calling a therapist, but held out long enough that things seem to get better. For some, that’s the usual course of things. For others, not seeking help means the problems of ongoing life dissatisfaction, depression, anxiety or problem drinking keep recurring and sometimes they worsen. Therapy helps people pull out of their depressed moods, tackle their anxiety, deal more effectively with interpersonal conflicts, and reduce or eliminate problematic substance abuse. It often helps people to also avoid the recurrence of such problems.

Sometimes, life just happens. Difficult, sometimes tragic and terribly unjust things also happen to us or to the people we love and it's just hard to bear it without someone to talk to. There's no shame in getting therapy. Asking for help may just be the bravest decision. Does Psychotherapy Work? If you are seeking psychotherapy you are probably asking yourself some questions. Does psychotherapy really work? If it does, what kind of therapy works? How do I pick a good therapist? Psychologists have been studying these questions too. The short answer to the first question is YES, therapy works most of the timefor most people seeking it. A more complete answer requires at least a brief review of the research that bears on the question. This section is more of an academic and dry read, but I provide it for those people who desire more of this kind of information before making a decision to enter therapy. There are two broad types of studies used to understand what makes for good psychotherapy, studies of efficacy and studies of effectiveness. Efficacy studies contrasts some kind of therapy to a comparison group under controlled, lab-like conditions. These studies are essential to our understanding of what works. However, life outside the lab is more complex and so are the problems of people who most often seek treatment. Effectiveness studies examine therapy with real-world clinicians and clients. The job of the psychologist or therapist is to translate efficacious practices, proven effective in the lab, into routine practice settings to produce effective results for their clients.Effectiveness StudiesA compelling and classic study on the effectiveness of psychotherapy, conducted by Consumer Reports, sampled middle class consumers who sought help for common problems like anxiety, depression, and substance abuse. I will summarize the study and results here. 7,000 (32%) of people responding to their annual survey about products and services answered questions about mental health. 2,900 sought treatment from a mental health professional. They were asked about specific improvements in the problem they sought help for, satisfaction with the treatment provider, and overall change in their emotional state. They reported,

Treatment by a mental health professional usually worked. Most respondents got a lot better.

Of the 426 people who were feeling very poor when they began therapy, 87% were feeling very good, good, or at least so-so by the time of the survey.

Of the 786 people who were feeling fairly poor at the outset, 92% were feeling very good, good, or at least so-so by the time of the survey.

Long-term therapy produced more improvement than short-term therapy.

Active shoppers and active clients did better in treatment than passive recipients.

No specific modality of psychotherapy did any better than any other for any problem.

Academic Review of Efficacy and Effectiveness ResearchIn another classic study of psychotherapy effectiveness was conducted by Mary Lee Smith and Gene Glass at the University of Colorado in 1977. They reviewed 1,000 journals and books and compiled a group of 375 studies of the effects of psychotherapy. The average age of the subjects in all these studies was 22. They had received an average of 17 hours of therapy. Smith and Glass found,

The average client receiving therapy was better off than 75% of the untreated controls.

Different therapy types produced similar results.

Subsequent research has continued to improve upon these earlier studies and have produced a couple decades of careful scientific research that supports the efficacy and effectiveness of psychotherapy. These results include studies of different kinds of problems, individuals, and treatment settings. The findings of this collection of research indicates,

75-80% of patients who enter therapy show benefit

Having a good, trusting, therapeutic alliance with a therapist contributes the most to patient’s getting better.

This is not a comprehensive review of the field psychotherapy effectiveness, so we can’t conclude that that all psychotherapy is equally effective for all problems and all people. We know that some therapies and therapist styles might be a more effective match for some clients, their life circumstances, and specific problems. For example, it has been demonstrated that behavior therapies are significantly more effective than non-behavioral approaches in the treatment of phobias and panic disorder. Effectiveness of Cognitive Behavioral Therapy (CBT)

CBT is one of the most researched forms for psychotherapy. 30 years of research has consistently shown it to be effective for helping people with depression, anxiety, substance abuse, and interpersonal problems. I use CBT in my practice. I help my clients by first seeking to understand their life, their learning history, and their current struggles. Then we work collaboratively within the CBT treatment approach to build on their knowledge of themselves and help them develop self-monitoring strategies (what is sometimes called mindfulness or metacognitive skills). This work builds on itself by helping them interrupt their undesired, automatic reactions to events. Then we work to build in self-reflection strategies to help them make more conscious and nuanced evaluations of situations and engage in more deliberate choices and behavioral responses. In turn, this learned process promotes more adaptive living and more harmonious lives. Choosing a Therapist The most important consideration when choosing a therapist may not by the type of therapy, but your expectations of psychotherapy. Research and my clinical experiences consistently show that if you believe that psychotherapy can help you, and you begin therapy with optimistic expectations, you are more likely to get better. The connection you feel with the therapist can also make an important difference too. If you see your therapist as genuine, caring, warm, and able to achieve empathy with you, you are much more likely to experience effective and rewarding therapy.Further Reading about the Topics Above Butler, A. C., Chapman, J. E., Forman, E. M., Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31. [Link]